Enrolling in Medicare is a major milestone—but it’s also just the beginning of your health insurance decisions in retirement. For many people who choose Original Medicare (Parts A and B), the next big question becomes: Should I get a supplemental Medicare plan, also known as Medigap?

This decision is often clouded by myths and misconceptions. Some people believe Original Medicare is “enough,” while others assume Medigap is just an expensive add-on. In truth, whether or not you need a supplemental plan depends on your healthcare needs, financial situation, and risk tolerance. Let’s separate fact from fiction so you can make a fully informed decision.

What Is a Supplemental Medicare Plan?

Supplemental Medicare plans, commonly referred to as Medigap plans, are private insurance policies designed to help pay for costs not covered by Original Medicare. This includes expenses such as:

• Deductibles (for both Part A and B)
• Copayments
• Coinsurance
• Excess charges

Medigap plans are sold by private insurers but are standardized by the federal government, meaning Plan G from one company offers the same coverage as Plan G from another. What varies is the cost, customer service, and added perks.

What Original Medicare Doesn’t Cover

Understanding what Original Medicare doesn’t cover is essential to appreciating the value of a Medigap plan. While Parts A and B do a good job covering hospital and outpatient care, they leave behind significant out-of-pocket expenses.

Original Medicare does not include:

• A cap on out-of-pocket spending
• Coverage for most prescription drugs
• Dental, vision, and hearing services
• Long-term custodial care

If you’re hospitalized or require frequent outpatient care, the 20% coinsurance with no annual limit can add up quickly. Medigap plans help fill in these gaps and provide financial predictability.

Common Myths About Supplemental Medicare Plans

Let’s examine and debunk some of the most common myths about Medigap coverage:

Myth #1: “Medicare covers everything—I don’t need extra coverage.”

Original Medicare is comprehensive, but far from complete. Without Medigap, you’re responsible for 20% of most medical services, and there’s no cap on what you could owe in a given year. A single serious illness could result in thousands of dollars in out-of-pocket expenses.

Myth #2: “Medigap is too expensive.”

While premiums for Medigap plans vary based on plan type, location, age, and insurer, many people find the peace of mind and cost predictability well worth the investment. It also helps avoid surprise bills during a health crisis.

Myth #3: “I can get a Medigap plan any time I want.”

Timing is everything. The best time to buy a Medigap plan is during your Medigap Open Enrollment Period —a six-month window that begins when you are both 65 or older and enrolled in Part B. During this period, insurers cannot deny you coverage or charge more based on pre-existing conditions. After that, underwriting may apply, and acceptance isn’t guaranteed.

Myth #4: “All Medigap plans are the same.”

While plans with the same letter offer the same benefits, not all plans are equal in terms of cost, reputation, and service. Plan G and Plan N, for example, both offer strong coverage but differ in how they handle certain copays and excess charges. Choosing the right plan requires evaluating how often you visit the doctor, your budget, etc.

Myth #5: “Medigap and Medicare Advantage are the same thing.”

This is a crucial distinction. You cannot have both a Medigap and a Medicare Advantage plan at the same time. Medicare Advantage (Part C) is an all-in-one alternative to Original Medicare, typically including drug coverage and extra benefits like vision and dental. Medigap only works with Original Medicare and helps cover the costs that Medicare doesn’t.

Popular Medigap Plans: What’s Covered?

There are 10 standardized Medigap plans labeled A through N. Plans F and C are no longer available to new Medicare enrollees as of January 1, 2020. Among the remaining options, Plan G and Plan N are two of the most popular.

• Plan G: Covers everything except the Part B deductible. This plan is often favored for its comprehensive protection and simplicity.
• Plan N: Lower premiums than Plan G but requires copays for some office and ER visits. It also doesn’t cover Part B excess charges.

These plans allow people to budget more predictably for healthcare expenses, especially as they age and anticipate needing more services.

How Medigap and Prescription Drug Coverage Work Together

Medigap plans do not include prescription drug coverage. If you choose a Medigap plan, you’ll also need to enroll in a standalone Medicare Part D plan to get prescription drug benefits.

Be aware that delaying enrollment in Part D without creditable drug coverage could result in a late penalty. The best time to enroll in Part D is during your Initial Enrollment Period—when you first become eligible for Medicare.

When Is a Medigap Plan the Right Choice?

Medigap plans are typically a better fit for individuals who:

• Want nationwide provider access without referral requirements
• Prefer predictable costs and fewer out-of-pocket surprises
• Don’t need built-in extras like vision or gym memberships
• Are willing to pay a monthly premium in exchange for cost stability
• Anticipate regular medical care or chronic condition management

People who travel frequently or split their time between states often appreciate the flexibility of Original Medicare plus Medigap, as there are no restrictive provider networks.

When a Medicare Advantage Plan Might Make More Sense

While Medigap offers strong financial protection, a Medicare Advantage plan may be better suited for:

• Those looking for lower monthly premiums (sometimes even $0)
• Individuals who want bundled extras like dental, vision, hearing, and wellness programs
• People comfortable with staying in a local provider network
• Those who don’t expect to need frequent or complex medical care

Each option has pros and cons, and it’s important to compare both based on your needs.

Timing Your Decision

To maximize your choices and avoid medical underwriting, it’s best to enroll in a Medigap plan during your one-time Medigap Open Enrollment Period. This is your guaranteed right to buy any plan sold in your state without denial or rate increases due to pre-existing conditions.

If you wait, you may still be able to enroll, but your options could be limited, especially if you have chronic health issues. Some states offer more protections than others, so knowing your state’s rules is vital.

How Croft Insurance Can Help

Navigating Medigap choices isn’t something you have to do alone. At Croft Insurance, our licensed agents help you:

• Understand which Medigap plan aligns with your medical and financial needs
• Compare costs across reputable insurers
• Clarify differences between Medigap and Medicare Advantage
• Time your enrollment to avoid underwriting or penalties
• Pair your plan with a compatible Part D policy for complete coverage

We take the time to walk you through every option, so your decision is confident—not rushed.

At Croft Insurance, we help you weigh the pros and cons, compare plans, and choose coverage that reflects your health goals and financial realities. Ready to explore your options?

Let’s schedule a personalized consultation.